Retractor apparatus

ABSTRACT

A retractor apparatus for attachment to a rail of a surgical table includes first, second and third support rods and first, second and third clamps. The first support rod is attached to the rail of the surgical table and permits movement about and along a vertical axis of the first rod. The second rod is attached to an upper section of the first rod with the second clamp. The second clamp permits movement of the second support rod about an axis of the first rod and about an axis of the second support rod and permits pivotal movement of the second rod with respect to the first rod about a pivotal axis of the second clamp. The third clamp clamps the third rod to the second rod and permits movement of the third rod along and about the axis of the second rod and about the axis of the third rod and permits movement about a pivotal axis of the third clamp. The third rod includes first and second spaced apart leg portions that extend over the surgical table on opposite sides proximate the incision for support of retractors.

This is a division of application Ser. No. 06/669,362, filed Nov. 8,1984, now U.S. Pat. No. 4,617,916.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to surgical retractor apparatus, and inparticular, it relates to a retractor apparatus that is attacheddirectly to an operating table rail for use in surgery.

2. Description of the Prior Art

In abdominal and chest surgery, it is customary to use a retractorapparatus that is directly mounted to the operating table. The apparatusincludes retractors that hold back tissue proximate to the surgicalincision to enable the surgeon to work in areas such as the abdominalarea or chest cavity.

Most retractor apparatus are positioned above a surgical drape thatdefines the sterile area where the surgeon and other attendants need tomove to perform the surgery correctly and efficiently. The usefulness ofany retractor apparatus is limited by the number of ways that theretractors can be positioned with respect to the incision of the bodyand with the ease and simplicity that the surgeon can adjust therelative position of the retractor before and during surgery. Inaddition, the retractor apparatus should not pose any great obstructionsto the surgeon's movement during surgery or take up a great amount ofspace, limiting the movement of the surgeon and other attendants.

There have been many attempts in developing a suitable retractorapparatus. For example, the following patents illustrate retractorsand/or retractor support apparatus that are movable along a singleplane:

    ______________________________________                                        Inventor       U.S. Pat. No.                                                  ______________________________________                                        Sloan          1,707,689                                                      Smith          2,586,488                                                      Smith          2,594,086                                                      Cooper         2,893,378                                                      Raeuchie       3,038,468                                                      Kohlman        3,749,088                                                      Gauthier       3,965,890                                                      Trumbull et al 3,998,217                                                      Gauthier       4,010,741                                                      Hursom         4,048,987                                                      Gauthier       4,337,762                                                      Estes et al    4,421,107                                                      Cabrera        4,421,108                                                      ______________________________________                                        Country        Patent No.                                                     ______________________________________                                        Italy            446,439                                                      ______________________________________                                    

In addition, there are several patents and one brochure that illustratedevices and apparatus that permit pivotal movement of the retractorand/or some component of the apparatus about one axis with some alsoincluding movement along one plane:

    ______________________________________                                        Inventor       U.S. Pat. No.                                                  ______________________________________                                        Van Meter        497,064                                                      Spurr          1,168,574                                                      Crossley       1,230,873                                                      Barlow et al   2,623,517                                                      Nelson         2,670,732                                                      Grieshaber     3,040,739                                                      Jensen         3,572,326                                                      LeVahn         4,355,631                                                      ______________________________________                                        Country        Patent No.                                                     ______________________________________                                        Italy            446,439                                                      Germany          460,145                                                      ______________________________________                                    

BROCHURES

"Pilling Retractor Systems", four-page brochure of Narco Scientific,Pilling Division, Fort Washington, Pa. dated 12/81.

There are also several patents, brochures and articles that eitherillustrate or discuss retractor apparatus that permit pivotal movementabout two axes with some also permitting movement along a single plane:

    ______________________________________                                        Inventor       U.S. Pat. No.                                                  ______________________________________                                        Nelson           267,599                                                      Straus         1,747,799                                                      Skelton        2,066,699                                                      Zoll et al     2,670,731                                                      Thompson et al 3,221,743                                                      Szpur          3,810,462                                                      McGuire        3,823,709                                                      Baitella       3,910,538                                                      Meier et al    4,143,652                                                      McCready et al 4,254,763                                                      ______________________________________                                        Country        Patent No.                                                     ______________________________________                                        France         1,235,185                                                      ______________________________________                                    

BROCHURES

"Thompson Retractor," two-page brochure of Richard C. Thompson, M.D.,San Mateo, Calif.

Price List of Automatic Retractor Holder of Great Eastern LumberCompany, Inc., N.Y., N.Y.

"Bookwalter Retractor," two-page brochure of Codman & Shurtleff, Inc.,Randolph, Mass.

ARTICLES

King, W. B., "Use of Table-Fixed Abdominal Retractors," American Journalof Surgery, Vol. 108, pp. 606-609, Nov. 1964.

Thompson, R. C. et al, "Mechanical Aids at the Operating Table,"California Medicine, Vol. 97, No. 1 pp. 28-30, July 1962.

At least two prior art patents, the Milo U.S. Pat. No. 3,858,578 and thePoletti U.S. Pat. No. 3,638,973 disclose retractor arms that are movablethrough the use of ball joints. Although ball joints provide a greatdegree of flexibility and movement, holding power and rigidity aresacrificed.

In many of the above prior art references, the surgeon does not have theability to position the retractor universally, but is limited by thelimited movement of retractor support apparatus. In addition, some ofthe developments in retractor apparatus in attempting to improveversatility in movement have sacrificed space and created obstructionsfor the surgeon.

SUMMARY OF THE INVENTION

The present invention provides a retractor apparatus that allows thesurgeon to quickly position and adjust retractors along at least threeaxes of rotation. The retractor support apparatus includes first, secondand third rigid support rods and first, second and third clampingmechanisms. The first clamping mechanism connects a lower section of thefirst support rod to the rail of the operating table. The second rod isconnected to an upper section of the first rod by the second clampingmechanism. The second clamping mechanism permits pivotal movement of thesecond rod about the first rod and movement of the second rod about itsown axis and movement of the second rod about an axis of the clampingmechanism. The third rod includes spaced-apart leg portions extending onopposite sides of the incision. Retractors are supported from the thirdrod. The third rod is connected to the other end of the second rod bythe third clamping mechanism. The third clamping mechanism permits thethird rod to be pivoted about the axis of the second rod and pivotedabout its own axis and pivoted with respect to the second rod about thepivotal axis of the third clamping mechanism.

The retractor apparatus of the present invention permits the surgeon, orone of his attendants, to adjust the relative position of the retractorsby simply operating any one of the clamping mechanisms, alone or incombination, with a minimum of effort. The apparatus provides movablejoints through the clamping mechanisms while also providing a joint thatis exceptionally rigid, just as rigid as the support rods. The supportapparatus does not require much space and provides little obstruction tothe surgeon and attendants.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of the retractor support apparatus of thepresent invention.

FIG. 2 is an exploded perspective view of one clamping mechanism of thepresent invention.

FIG. 3 is a sectional view of the clamping mechanism of FIG. 2 withportions shown whole.

FIG. 4 is an exploded perspective view of a retractor clamping mechanismof the present invention.

FIG. 5 is a sectional view of the retractor clamping mechanism of FIG. 4with portions shown whole.

FIG. 6 is an exploded perspective view of a clamping mechanism of anauxiliary retractor support device of the present invention.

FIG. 7 is a sectional view of the clamping mechanism of the auxiliaryretractor support device of FIG. 6 with portions shown whole.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

A retractor support apparatus of the present invention is generallyindicated at 10 in FIG. 1. The retractor support apparatus 10 is used tosupport one or more retractors 11, 13, 15 and 17 above an operatingtable 12. The operating table 12 has side rails 14 to which retractorsupports are commonly attached. The retractors are employed during majorsurgery, particularly of the chest or abdomen, and are applied to tissueproximate an area 19 of a surgical incision to hold back the cut tissue.Holding back the cut tissue exposes the area 19 in which the surgeonmust work. The retractor support apparatus of the present inventionprovides a novel support that is movable about at least three axes sothat a surgeon can adjust the position of the retractors in a quick andefficient manner before or during surgery.

The support apparatus 10 includes a side rail clamping device 16 thatclamps onto a side rail 14 of the operating table 12. The side railclamping device 16 is described in U.S. Pat. No. 4,355,631 issued to theinventor as the present application and assigned to the same assignee ofthe present invention and is hereby incorporated by reference. The clamp16 is used to connect primary support rod 18 to the railing 14. Thesupport rod 18 has a lower substantially vertical section 20 and anupper substantially horizontal section 22 and preferably a midsection 24disposed angularly with and connecting the lower and upper sections witheach other. The lower section 20 insertably engages the clamp 16 so thatwhen the clamp 16 is loosened, the support post 18 is movable in asubstantially vertical direction as indicated by arrow 26 and is fixedlyretained with respect to rotation about the axis of the lower section20.

A pivotal clamp 30 pivotally connects the upper section 22 of thesupport 18 with an extension rod 32. The extension rod 32 is retained inposition in a rigid and fixed fashion, and when the clamp is released,the rod 32 is movable about three separate axes or has three degrees offreedom. First, the clamp 30 is rotatably movable about the axis of theupper section 22 of the support member 18, as indicated by arrows 34.Second, the clamp permits pivotal movement of the extension rod 32 abouta pivotal axis running through the clamp as indicated by arrows 36.Third, the extension rod is rotatable about its own axis, as indicatedby arrows 38. In addition, the rod 32 is movable along the axis of theupper section 22 and is movable along its own axis.

The clamp 30 is more fully illustrated in FIGS. 2 and 3. The clamp 30includes a lower clamping section 40 and an upper clamping section 42 ina pivotal relationship about a pivot axis 44. A retaining bolt 46,having a lower threaded section 48, extends through a bore 50 of theupper clamping section 42 and into a threaded bore 52 in the lowerclamping section 40.

The lower clamping section 40 is of a unitary construction, preferablymachined from a single block of stainless steel, and has an upper and alower leg 54 and 56 separated by a slot 60. The slot 60 extends from oneend 61 of the clamping section 40 to a clamping bore 62 locatedproximate an opposite end 63. The clamping bore 62 receives and clamps arod section, such as section 22, described with reference to FIG. 1. Thelegs 54 and 56 are resiliently movable with respect to each other suchthat the clamping bore 62 is reduced sufficiently in size tofrictionally clamp the rod section.

Similarly, the upper clamping section 42 is of a unitary construction,preferably machined from a single piece of stainless steel, and includesan upper leg 64 and a lower leg 66, separated by a slot 68. The slot 68extends from one end 69 of the clamping section to a clamping aperture70 proximate an opposite end 71. The legs 64 and 66 are resilientlymovable with respect to each other such that the clamping bore 62 isreduced sufficiently in size to clamp a rod, such as rod 32, asdescribed with reference to FIG. 1.

The lower clamping section 40 has an upwardly-extending frusto-conicalportion 72 on an upper surface 74 thereof for frictional engagement witha frusto-conical recess 76 disposed in the lower leg 66 of the upperclamping section 42. The aperture 52 is disposed substantially coaxiallywithin the frusto-conical portion 72. The aperture 50 communicates withand is disposed substantially coaxially with respect to thefrusto-conical recess 76. The frusto-conical portion 72 insertablyengages the frusto-conical recess 76 so that the clamping section 40 andthe clamping section 42 pivot about the axis 44 with the apertures 50and 52 in substantial alignment.

The bolt 46 has a head portion 78 opposite from the threaded section 48.The head portion 78 has first and second upwardly extending retainingmembers 79 and 81 respectively, separated by a slot 84. The retainingmembers 79 and 81 have substantially aligned apertures 88 and 89,respectively. A handle 80 has a slot-engaging portion 82 that movablyengages the slot 84 of the head portion 78. The slot-engaging portion 82of the handle 80 has an aperture 86 extending therethrough that isalignable with an apertures 88 and 89. A spring pin 90 insertablyengages the apertures 88, 86 and 89 to pivotally attach the handle 80 tothe head portion 78. The handle 80 is pivotal about the pin 90 from oneside of the bolt to another side of the bolt 46, approximately 180° tofacilitate turning of the bolt 46.

A friction-reduction ring 92 is disposed between the upper clampingsection 42 and the head portion 78 of the pin 46. The ring engages anannular flange 94 of the head portion 78 defining the lowermost sectionof the head portion 78. The ring 92 is made of a material that reducesfriction between the flange 94 and the clamping section 42. One suitablematerial is sold under the trademark "DELRIN" by DuPont De Nemours & Co.of Wilmington, Del.

To operate the clamp 30, rods are inserted into the clamping bores 62and 70 of the clamping sections 40 and 42, respectively, such as rod 32and rod section 22, as illustrated in FIG. 1. The rod 32 and rod section22 are pivotally moved about the axis 44 by pivoting the clampingsections 40 and 42 with respect to each other. The rod 32 is moved in aselected position within the bore 70 and the bore 62 is moved in aselected position on the rod section 22. The bolt 46 is then turned,preferably clockwise, moving the legs 54 and 56 toward each other,thereby frictionally retaining the rod in the bore 62, and moving thelegs 64 and 66 toward each other frictionally retaining the rod in thebore 70, and frictionally binding the frusto-conical section 72 with thefrusto-conical recess 76 such that the clamping sections 40 and 42 arerestricted from movement with respect to each other. The frusto-conicalsection and frusto-conical recess provide a large area of metal to metalcontact to securely retain the clamping section in a clamping position.The ring 92, being made of a low friction material, helps to turn thebolt 46 more tightly and therefore increasing the clamping force of theclamping sections 40 and 42.

To loosen the clamp 30, the handle 80 is simply turned in an oppositedirection, almost immediately releasing the clamping sections 40 and 42from frictional engagement and permitting the legs 54 and 56 and legs 64and 66 to move away from each other releasing the rods within the bores62 and 70, all respectively. It will be appreciated that by simplyturning the bolt 46 the rod 32 and anything attached to the rod 32 isquickly and easily positioned about three axes and retained in positionand is quickly and easily released from position for further movement.

A second pivotal clamp 100 connects a retractor support rod 102 with theextension rod 32. The clamp 100 has the same structure as the clamp 30,described above with reference to FIG. 2. The clamp 100 permits pivotingof the retractor support rod 102 about the axis of the extension rod 32as indicated by arrows 38, and about an axis of a midsection 116 of theretractor support rod 102 and about a pivotal axis of the clamp asindicated by arrows 106.

The retractor support rod 102 has preferably two spaced apart legs 108and 110 which have angularly disposed sections 112 and 114,respectively, that are angularly disposed towards each other andconnected by the midsection 116. The legs 108 and 110 are spacedsufficiently apart so that the legs are arranged on either side of thearea 19 with sufficient room to position the retractors 11, 13, and 15.

It will be appreciated that the retractor support rod 102 is quicklypositionable by operating either clamp 16, 30 or 100 or any combinationof the three. The retractor support rod 102 can be raised vertically andmoved horizontally as indicated by arrow 28 by operation of clamp 16.The support rod 102 can be inclined, with respect to the horizontal,toward one end or the other end of the operating table by operation ofclamp 30 or 100 or both. In addition, operation of clamps 30 and 100permit the support rod 102 to be tilted towards the left or the rightside of the operating table. The retractor support rod 102 is alsomovable along the longitudinal axis of the operating table by adjustingthe position of the extension rod 32 and the support post 18 andoperation of clamps 16, 30 and 100.

The retractors 11, 13 and 15 are pivotally attached to the retractorsupport by retractor clamps 118, 120 and 122. The retractor clampsprovide three degrees of freedom in positioning each of the retractors.The retractor 11 includes a retractor blade 124 and a retractor handle126 attached to the blade and insertably engaging the clamp 118.Similarly, the retractors 13 and 15 have blades 128 and 130, and handles132 and 134, which are inserted into clamps 120,122, all respectively.

The support rod 102 has corner portions 103 and 105 of reduced diameter,that is, a diameter smaller than that of sections 108, 112, 114 and 110.The corner portions 103 and 105 have a diameter sufficiently smallerthan the adjacent sections 108 and 112 and adjacent sections 110 and 114so that the retractor clamps are movable between sections 108 and 112,and 110 and 114 by only slightly loosening the clamp so that it ismovable along the rod sections 108, 112, 114 and 110. The reduceddiameter of the corner portions permits movement of slightly loosenedclamps between rod sections.

The clamps 118, 120 and 122 are of similar construction and aredescribed collectively with reference to a clamp 136 illustrated inFIGS. 4 and 5. The clamp 136 includes a lower clamping section 138, anupper clamping section 140, a friction-reduction ring 142, a headsection 144 and a handle 146. The lower clamping section, the upperclamping section, ring 142 and head section 144 are disposed coaxiallyabout an axis 148. The axis 148 is considered the pivot axis about whichthe retractor is pivoted, as indicated by arrows 150 in FIG. 1.

The lower clamping section 138, as illustrated in FIGS. 4 and 5,includes a lower clamping jaw 152 and an upper clamping jaw 154. A bolt156 extends upwardly through an aperture 157 in the lower clamping jaw152. The bolt 156 has a threaded upper end 158 and is coaxially disposedon the axis 148 and extends through an aperture 160 of the upperclamping jaw 154. A pin 162 fixedly attached to the lower jaw 152 alsoextends upwardly and through a bore 164 in the upper clamping jaw 154.The pin 162 and bolt 156 cooperate to retain the upper and lowerclamping jaws 152 and 154 in clamping alignment with each other.

The lower clamping jaw 152 has a lower clamping groove 166 and the upperclamping jaw has an upper clamping groove 168 facing the lower clampinggroove 166. The lower clamping groove 166 and the upper clamping groove168 are aligned along their longitudinal axis, as best illustrated inFIG. 5, for clamping the retractor support rod 102, as illustrated inFIG. 1.

A coil spring 170 is coaxially disposed about the bolt 156. The coilspring, at a lower end, abuts against an upper surface of the clampingplate 152 and extends into a downwardly facing bore 172 of the upperclamping plate 154. The bore 172 is disposed coaxially with respect tothe bore 160 and the axis 148 and forms a downwardly facing shoulder 174against which the spring 170 abuts at an upper end. The spring 170provides a force to separate the lower and upper clamping sections 152and 154 from a clamping position.

The upper clamping section 140 includes a lower clamping leg 176 and anupper clamping leg 178 separated by a slot 180 that extends from an end181 of the upper clamping section up to a retractor handle clampinggroove 182 located proximate an opposite end 183. The upper clampingsection 140 is of a unitary construction, preferably machined from asingle block of stainless steel. The legs 176 and 178 are resilientlymovable with respect to each other such that the clamping bore 182 isreduced sufficiently in size to frictionally clamp a retractor handle184. The retractor handle 184 represents retractor handles 126, 132 and134, as illustrated in FIG. 1.

The upper clamping section 140 also includes a bore 186 coaxiallydisposed about the axis 148 and through which the bolt 156 extends. Whena force is applied such that the legs 176 and 178 are pushed towardseach other, the clamping groove 182 clamps around the handle 184 of theretractor securing the retractor in a fixed position.

The friction-reduction ring 142 abuts against an upper surface of theupper clamping section 140. The ring 142 includes an annular shoulder184 whose outer periphery is defined by an annular wall 186. The headsection 144 has a lower annular flange portion 188 that engages theannular shoulder 184 of the ring 142 with the wall 186 engaging sides ofthe flange 188. The head section 144 includes spaced apart upwardlyextending handle retaining members 190 and 192 separated by a slot 194,as best illustrated in FIG. 4. A pin receiving bore 196 extends throughthe retaining member 192 and is in alignment with another pin receivingbore (not shown) extending through retaining member 190.

The handle 146 includes a slot engaging portion 198 that movably engagesthe slot 194. The slot engaging portion 198 includes a third pinreceiving bore 200 that is alignable with the first pin receiving bore196 and the second pin receiving bore in the member 190 (not shown). Aspring pin 202 engages the bore 196, the bore 200 and the bore (notshown) in the member 190 such that the handle 146 pivots about the pin202 within the slot 194. The handle 146 is pivotable approximately 180°from a substantially horizontal position on one side of the head section144 to an opposite side of the head section 144 to facilitate theoperation of the retractor clamp regardless of the relative position ofthe handle 146.

The head section 144 includes a downwardly facing bolt engaging threadedbore 204 that is coaxially aligned with the bore 186 of the upperclamping section and the aperture bore of the upper clamping jaw 154such that the bolt 156 extends through the bore 160, the bore 186 andinto the bore 204, threadably engaging said bore 204.

When the head section 144 is turned clockwise by grasping the handle146, the lower clamping jaw 152 and the upper clamping jaw 154 are movedtowards each other against the force of the spring 170 and the clampinglegs 176 and 178 of the upper clamping section 140 are also movedtowards each other substantially simultaneously clamping a retractorhandle positioned within the clamping grooves 166 and 168 and theretractor support rod 184 in the clamping bore 182. To release theretractor from a clamping position within the clamping grooves 166 and168 and to release the clamp from the retractor support rod 184, thehandle is turned in the opposite direction, turning the head 144 withthe spring 170 acting to separate the upper and lower clamping jaws 152and 154 and the legs 176 and 178 separating due to the resilient forcewithin the clamping section 140.

As is easily understood by those skilled in the art from the discussionabove, the retractor support apparatus requires very little space. Anyobstruction to the surgeon or the other attendants by the supportapparatus is minimal. Although the apparatus takes up a minimal amountof space, the support apparatus is a very rigid and durable structureprimarily due to the clamping mechanisms 30 and 100. The frusto-conicalsection and recess provide a retaining force that includes a large areaof metal to metal contact. Once the metal to metal contact isestablished, clamps 30 and 100 cannot be moved from their selectedpositions by any force normally found in the operating room, such as asurgeon or attendant leaning or bumping against the apparatus. Theretractor support rod 102, since it is a rod and not a flat plate,provides minimum obstruction to the surgeon working in the area 19.However, due to the structure of clamps 30 and 100, the retractorsupport rod 102 is held in a sufficiently rigid fashion that is capableof withstanding contact by the surgeon and other attendants whileretaining the position that had been previously selected.

An auxiliary retractor support device 210 is also illustrated in FIG. 1.The auxiliary retractor support device includes a first support rodsection 212, a clamping section 214 and a second retractor support rodsection 216. The auxiliary retractor support device is secured to thesupport rod 18 proximate a free end of the first rod section 212 by aclamp 218. The clamp 218 is of a similar structure as the clamp 30illustrated in FIGS. 2 and 3. The clamp 218 also provides three degreesof freedom for positioning the retractor support device 210 about threeseparate axes. First, the clamp 218 and the retractor device 210 arepivotable about an axis running through the support rod 18, as indicatedby the arrows 28. Second, the clamp 218, like the clamp 30, has a firstclamping section 220 and a second clamping section 222 which arepivotable about an axis generally indicated by the arrows 224. Theauxiliary retractor support device 210 is pivotable about the axisindicated by arrows 224 when the clamping section 222 is moved withrespect to the clamping section 220. Third, the retractor support deviceis pivotable about the axis of the rod section 212, as indicated byarrows 226 when the rod section 212 is rotated within the clamping boreof the clamping section 222. In addition, the device 210 is movablealong the support rod 18 and along the axis of the rod section 212.

The clamping device 210 is more fully illustrated in FIGS. 6 and 7. Theclamping device 210 permits pivoting of the rod sections 212 and 216about an axis 228 running through the clamping section 214. The clampingsection 214 includes a lower clamping member 230, a resilient bushing232 and an upper clamping member 234. The clamping device also includesa friction-reduction ring 236, a turning bolt 238 for bringing theclamping members 230 and 234 in clamping relationship, and a handle 240for turning the bolt 238.

The rod section 216 is preferably permanently attached to the lowerclamping member 230. The lower clamping member 230 includes an upwardlyfacing threaded bolt receiving bore 242 for receiving the bolt 238 inthreaded cooperation. The lower clamping section includes an upwardlyextending frusto-conical portion 244 in coaxial alignment with the bore242. The frusto-conical portion 244 includes a bushing retaining bore246 in substantially coaxial alignment with the bore 244. The bore 244has a lower shoulder 248 for supporting the bushing 232. The bushing 232has a bolt receiving bore 250 disposed coaxially along the axis 228. Thebushing 232 is positioned within the bore 246 and rests on the shoulder248. The bushing 232 has an upper portion 252 that extends above thefrusto-conical portion 244. The bushing 232 is made of a resilientmaterial, such as a medical grade rubber that can be sterilized, andprovides a force to separate the clamping members 230 and 234 from theclamping position.

The upper clamping member 234 includes a bore 253 and downwardly facingfrusto-conical recess 254, both coaxially aligned along the axis 228.The frusto-conical recess has an upper shoulder 256 that defines theupper limit of the recess and engages the top of the bushing 232. Thebushing 232 acting against the shoulder 248 and the shoulder 256provides a force to separate the lower clamping member 230 from theupper clamping member 234.

The turning bolt 238 has a lower threaded section 258 and an upper headsection 260. The turning bolt 238 extends through the ring 236, throughthe bore 253 of the upper clamping member 234, through the bore 250 ofthe bushing, and into the bore 242 for threaded engagement. The headsection 260 of the turning bolt 238 includes a lower annular flangeportion 262 that engages the ring 236. The ring 236 is made of a lowfriction material, such as "DELRIN". The head section 260 includes firstand second handle retaining members 264 and 266 separated by a slot 268.A pin retaining bore 270 extends through the member 264 and a second pinretaining bore 272 extends through the member 262, as best illustratedin FIG. 7.

The handle 240 includes a slot engaging portion 274 that movably engagesthe slot 268 and includes a third pin engaging bore 276 that is alignedwith the bores 270 and 272. A spring pin 278 engages the bore 270, 276and 272 such that the handle is pivotal approximately from a horizontalposition on one side of the turn bolt 238 to an opposite side of theturn bolt 238 or approximately 180°.

When the turn bolt 238 is turned by turning the handle 240 in aclockwise direction, the upper and lower clamping members 234 and 230are forced together by the threaded engagement of the bolt with the bore242, moving the bolt through the bore 242. The frusto-conical section244 and frusto-conical recess 254 frictionally engage each other andretain the members 234 and 230 in a clamping position. When the handle240 is turned in an opposite direction, the force of the resilientbushing 232 separates the members 230 and 234 moving the clamping device210 from the clamping position.

Referring back to FIG. 1, the clamping device 210 permits movement ofthe retractor support rod section 216 about the axis of the clampingdevice as indicated by arrows 280. The device 210 is used as anauxiliary support alone or in combination with the support rod 102. Asillustrated in FIG. 1, the device 210 is positioned so that the rodsection 216 runs substantially parallel to the leg 110 of the rod 102.The retractor 17 is mounted to the rod section 216 so that it can beused in cooperation with the retractor 15 mounted on the leg 110 of therod 102.

The retractor 17 includes a clamping section 282 that clamps theretractor onto the rod section 216 by turning handle 284. The clampingsection 282 also permits pivoting of the retractor 17, as indicated byarrow 286, about an axis running through the clamping section 282.

The retractor 15 and the retractor 17 are used in combination to holdback different layers of tissue. The retractor 15 retains a first layerof tissue 288. The retractor 17 is spaced from the retractor 15, asindicated by arrows 290 and 292. The use of the auxiliary device 210provides the additional flexibility in being able to position theretractor 17 independently from the retractor 15. The device 210provides versatility since the rod section 216 is positionableindependently of the leg 110 of the rod 102. It will be understood thata separate support post, similar to the support post 18, can be clampedto the rail 14 on an opposite side of the table 12 so that the rodsection 216 can be positioned along the leg 108. Furthermore, the rodsection 216 can be positioned with respect to either sections 112 and114 of the rod 102 so that a retractor clamp thereon can be used inassociation with the retractor 13.

Although the present invention has been described with reference topreferred embodiments, workers skilled in the art will recognize thatchanges may be made in form and detail without departing from the spiritand scope of the invention.

What is claimed is:
 1. A clamping mechanism for connecting first andsecond rod sections of a retractor apparatus, the mechanism comprising:afirst clamping section having a unitary body with a first clamping boreextending therethrough proximate one end of the body and a slot runningthrough said body from the clamping bore to an opposite end of the body,separating the body into first and second resilient leg portions thatwhen brought together reduce the diameter of the first clamping bore forfrictionally clamping a rod section, the first clamping section furtherincluding a frusto-conical section extending from the first leg portion;a second clamping section having a unitary body with a second clampingbore extending therethrough proximate one end of the body and a slotrunning through said body from the clamping bore to an opposite end ofthe body, separating the body into first and second resilient legportions that when moved together reduce the diameter of the secondclamping bore for frictionally clamping a rod section, the second legportion having a frusto-conical recess for frictional engagement withthe frusto-conical section of the first clamping section such that whena force is applied bringing the first and second clamping sectionstogether and the leg portions of the respective clamping sectionstogether, each clamping bore frictionally clamps the respective rodsection and the frusto-conical recess and frusto-conical section areplaced in frictional engagement so that the first and second clampingsections are placed in a clamped position; and means for providing aforce to bring together the leg portions of the respective clampingsection and the first and second clamping sections together.
 2. Theclamping mechanism of claim 1 wherein the first and second clampingsections have first and second pivot bores coaxially aligned withrespect to a pivot axis running through the clamping sections andwherein the means for providing a force includes a turning boltextending through the pivot bores and threadably engaging the second legportion of the first clamping section to provide a force to bring theleg portions together when the bolt is turned.
 3. The clamping mechanismof claim 2 wherein the turning bolt includes a head section having firstand second spaced-apart handle retaining members, each handle retainingmember having first and second pin receiving apertures positioned alonga pin pivot axis and further including a handle having a sectionpositionable between the first and second retaining members and having athird pin receiving aperture alignable with the first and second pinreceiving apertures and a pivot pin insertably engaging the first,second and third apertures, such that the handle is pivotalapproximately 180°.
 4. A retractor clamping apparatus comprising:a firstclamping member with a first clamping groove; a second clamping memberhaving a second clamping groove facing the first clamping groove suchthat the first and second clamping grooves define a first clamping borewhich frictionally engages a support rod disposed within the clampingbore when the first and second clamping members are brought together ina clamping relationship; a support rod clamping section having a unitarybody with a second clamping bore extending therethrough proximate oneend of the body and a slot running through the body from the clampingbore to an opposite end of the body, separating the body into first andsecond resilient leg portions that when brought together reduce adiameter of the clamping bore for frictionally clamping a support rod;spring means for providing a force to separate the first and secondclamping members from a clamping position; and means for providing aforce to bring together the first and second clamping members to aclamping position and to bring together the leg portions of the rodclamping section to a clamping position.
 5. The apparatus of claim 4wherein the support rod clamping section has a pivot bore extendingthrough the leg portions and the first and second clamping member havingpivot bores extending therethrough and the means for providing a forceincludes a turning bolt extending through the pivot bores of the firstand second clamping members and the support rod clamping section and abolt engaging head member having a threaded bore for threadably engagingthe bolt such that when the bolt is turned to move through the threadedbore, a force is provided to bring the first and second clamping membersand the first and second leg portions of the retractor clampingapparatus together in a clamping position.
 6. The apparatus of claim 5wherein the head member includes first and second spaced-apart handleretaining members, each handle retaining member having first and secondpin receiving apertures positioned along a pin pivot axis and furtherincluding a handle having a section positionable between the first andsecond retaining members and having a third pin receiving aperturealignable with the first and second pin receiving apertures and a pivotpin insertably engaging the first, second and third apertures such thatthe handle is pivotal approximately 180°.